Case Report Annals of Clinical Case Reports Published: 20 May, 2019

Exploding Head Syndrome: A Case Report

Muhannad Hawari* and Fayez Al-Ahmadi Department of Medicine, King Faisal Specialist Hospital and Research Center, Saudi Arabia

Abstract Exploding Head Syndrome (EHS) is a rare type of a group of disorders called . It is characterized by the perception of a sudden loud noise in the head as the patient is falling asleep or awakening from sleep. The sound is described as a painless loud bang, an explosion, or a bomb exploding but can be a less alarming sound. We report a 60 years old lady with EHS describing this disorder and the assessment and management of it.

Introduction Exploding Head Syndrome (EHS) is characterized by the perception of a sudden loud noise in the head as the patient is falling asleep or awakening from sleep [1,2]. The sound is described as a painless loud bang, an explosion, or a bomb [3]. It is classified as a type of in the International Classification of Sleep Disorders (ICSD) 3rd edition and its pathophysiology is still unclear [3,4]. Armstrong-Jones first described it in 1920 [5]. Pearce coined the term ex­ploding head syndrome in 1989 in a paper in which he described 40 patients with EHS [1]. Case Presentation We report this 60 years old lady known to have hypertension and dyslipidemia who presented complaining of poor quality of sleep for 2 years. Her sleep schedule was suggestive of a total sleep time of 7 h per night with usually a regular sleep-wake schedule. Her sleep environment and habits of sleep were not suggestive of anything to cause sleep disruption. She had history of but no symptoms of restless leg syndrome or . She has no excessive daytime sleepiness (Epworth sleepiness scale was 4/24) and no symptoms to suggest an underlying neurological, psychiatric or medical disorders. She reports episodes of waking up at night with a loud sound in her head, which she could OPEN ACCESS not describe. The best description she was able to provide was “a loud sound as if blood is gushing *Correspondence: through my head”. It lasts for minutes and resolves spontaneously. It causes frequent awakenings at Muhannad Hawari, Department of night and sometimes she could not go to sleep. It was causing significant distress. Medicine, King Faisal Specialist Discussion Hospital and Research Center, Zahrawi St, Al Maather, Riyadh, 12713, Saudi Exploding Head Syndrome (EHS) is characterized by the perception of a sudden loud noise Arabia, Tel: 966504420248; in the head as the patient is falling asleep or awakening from sleep [1,2]. The sound is described E-mail: [email protected] as a painless loud bang, an explosion, or a bomb exploding but can be a less alarming sound [3]. Received Date: 22 Apr 2019 Occasionally; it is accompanied by the sensation of a flash of light. Accepted Date: 15 May 2019 Although these attacks themselves are usually not painful, it is reported that EHS attacks Published Date: 20 May 2019 may precede migraine as auras. EHS is classified as a type of parasomnia in the International rd Citation: Classification of Sleep Disorders (ICSD) 3 edition and its pathophysiology is still unclear [3,4]. It Hawari M, Al-Ahmadi F. Exploding Head was first described by Armstrong-Jones in 1920 [5]. The term exploding head syndrome was coined Syndrome: A Case Report. Ann Clin by Pearce in 1989 in a paper in which he described 40 patients with EHS [1]. It is thought to be a Case Rep. 2019; 4: 1658. migrainous phenomenon [1,6]. There have been different descriptions of the noise which include the sound of an explosion, gunshot, door slamming, roar, waves crashing against rocks, loud voices, ISSN: 2474-1655 a ringing noise, a terrific bang on a tin tray, or the sound of an electrical buzzing. In some cases, Copyright © 2019 Muhannad an instant flash of what is perceived as video ‘static’ is reported both audibly and visually for a Hawari. This is an open access fraction of a second [1,7]. It arises from the transition between different sleep stages and disappears article distributed under the Creative completely when awake, although it may recur on further sleep attempts [7]. There is no actual Commons Attribution License, which or persistent pain, but some patients may experience a brief, mild jab-like sensation. permits unrestricted use, distribution, and reproduction in any medium, Although EHS has been reported in patients as young as 10 years, the age of onset is usually provided the original work is properly after age 50 and the condition has a slight female preponderance. The attacks occur with variable cited. frequency for a few weeks or months. Attacks can be one-time events or can recur with attacks

Remedy Publications LLC., | http://anncaserep.com/ 1 2019 | Volume 4 | Article 1658 Muhannad Hawari, et al., Annals of Clinical Case Reports - Neurology increasing or decreasing over time, sometimes with no incidents over 3. Michael J Sateia. International classification of sleep disorders- Third long periods of time [1,7,8]. The cause of EHS is unknown; however edition. 2014;146(5):1387-94. some possibilities include a sudden movement of a middle ear 4. Okura M, Miura R, Inoue M, Taniguchi M, Ohi M. Polysomnograhic component or the Eustachian tube, or a brief temporal lobe complex findings in five patients with exploding head syndrome. Sleep. partial [9]. It may be related to emotional tenseness, as some 2017;40(1):A273. patients report a stressful life situation in periods' when attacks were 5. Armstrong-Jones R. Snapping of the brain. The Lancet. 1920;196(5066):720. intense and frequent [8]. There have been reports that the events might occur during stage N1 and N2 and maybe proceeded by 6. Palikh GM, Vaughn BV. responsive exploding head syndrome. J Clin Sleep Med. 2010;6(4):382-3. respiratory events [4]. 7. Ganguly G, Mridha B, Khan A, Rison RA. Exploding head syndrome: a It is thought to be a benign phenomenon and reassurance is case report. Case Rep Neurol. 2013;5(1):14-7. usually needed. Pharmacological options include calcium channel blockers like [10] or [11], topiramate [6] and 8. Sachs C, Svanborg E. The exploding head syndrome: polysomnographic recordings and therapeutic suggestions. Sleep. 1991;14(3):263-6. . All have been found to be effective in reducing the frequency or resolution of the EHS symptoms. 9. American Sleep Association: Exploding head syndrome. References 10. Jacome DE. Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia. 2001;21(5):617-8. 1. Pearce JM. Clinical features of the exploding head syndrome. J Neurol Neurosurg Psychiatry. 1989;52(7):907-10. 11. Chakravarty A. Exploding head syndrome: report of two new cases. Cephalalgia. 2008;28(4):399-400. 2. John A Fleetham, Jonathan AE Fleming. Parasomnias. CMAJ. 2014;186(8):E273-80.

Remedy Publications LLC., | http://anncaserep.com/ 2 2019 | Volume 4 | Article 1658